Statement of Responsibility

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  Texas Department of State Health Services icon Funding Information Center - Library icon 1100 W. 49th Street, Mail Code 1955 icon Austin, TX 78756-3199 icon Toll free: 1-888-963-7111 ext. 7684 icon Austin phone: (512) 776-7684 icon Fax: (512) 776-7683


 

Books and CDs in the Texas Department of State Health Services Funding Information Center collection are inventoried state property. The person requesting item(s) and receiving them assumes all responsibility for borrowed item(s). Borrower responsibility includes:

1. Prompt return of items by the scheduled date. The borrower is responsible for return shipping costs. Any borrower having two (2) late returns will have their borrowing privileges suspended. You may renew items by contacting the Funding Information Center. No further confirmed orders will be shipped to borrowers with materials outstanding. Willful failure to return borrowed publications upon request will be viewed as theft of state property a violation of Section 31.03, Texas Penal Code, the conviction of which could, depending on value, result in a fine not to exceed $500 (Class C Misdemeanor), to confinement of up to 10 years and a fine up to $10,000 (Third Degree Felony). Please return the items by U.S. mail, UPS or other insured carrier. A return mailing address label is enclosed for return of item(s).

2. Replacement of lost or damaged item(s). The item(s) returned by U.S. mail should be insured for at least $25 each. Borrowers will be liable for returned uninsured shipment lost in transit. In the event of loss or damage to a publication, the Funding Information will invoice the borrower for the full replacement value of the item(s).

3. Copyright compliance. Borrowed item(s) cannot be duplicated without prior written permission from the copyright owner. Violations of federal copyright law will result in the immediate suspension of library borrowing privileges and prosecution by the copyright owner can result in financial penalties and/or jail.

4. Privacy Notification. With a few exceptions, you have the right to request and be informed about information that the State of Texas collects about you. You are entitled to receive and review the information upon request. You also have the right to ask the state agency to correct any information that is determined to be incorrect. See http://www.dshs.state.tx.us for more information on Privacy Notification. (Reference: Government Code, Section 552.021, 552.023, 559.003 and 559.004)

I acknowledge financial responsibility to the State of Texas should items borrowed be lost, stolen, or damaged from the date I receive the items until the publication(s) have been returned to the library. I have read and agree to the terms in the Statement of Responsibility listed above.

PLEASE PRINT CLEARLY

_____________________________________(____)_______________(____)______________
Print Name                                                    Phone number                   Fax number

_____________________________________________________________________________ Organization                                                                      Mailing address

_____________________________________________________________________________ City                                                     Zip                                                    County

_____________________________________________________________________________
E-mail address          

____________________________________________________________________________
Signature                                                                                               Date

Please mail or fax the completed form to the Funding Information Center.

 

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Last updated June 21, 2011